Fax

Reservation Form Via Fax
Print it and Fax it to +1 347 287 6978

First and Last Name_______________________________________________________________________________
 
Address_________________________________________________________________________________________
 
City______________________________________State_______________________ZIP/Post Code_______________
 
Country_________________________________________________________________________________________
 
Email___________________________________________________________________________________________
 
Confirm Email____________________________________________________________________________________
 
Telephone______________________________________ Fax_____________________________________________
 
 
Card   Visa [ ]     Mastercard [ ]   America Express [  ]
 
Card Number___________________________________________________________________
 
Cardholder’s Name________________________________________________________________________________
 
Expiry Date ______/________
 
 
Signature_____________________________________ (Required)
 
 
Birthdate______________________________________(Required)
 
 
 
    Accommodation                  Arrival Date               Departure Date               N. Guests

     ___________________    _________________    __________________       _____________
     ___________________    _________________    __________________       _____________
 
 
Speciale requests:
 
_____________________________________________________________________________________________
 

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